How do clinicians address vaping in an illegal context? A qualitative Singapore study

Despite a strict vaping ban also covering purchase, use and possession, vaping has become more prevalent in Singapore. As more countries seek to regulate vaping, with no tailored services or guidelines for vaping cessation, clinicians may face additional challenges in identifying or treating vaping cases due to stigma or patients' reluctance to disclose their vaping. Few studies have explored how clinicians identify or manage vaping cases in a context where vaping is heavily regulated or stigmatised.

We conducted semistructured interviews with 12 Singapore practitioners from pharmacy, psychology, respiratory medicine, smoking cessation or youth welfare settings, all of whom had encountered vaping cases in their practice. Interviews explored how they manage vaping cases. We analysed data using inductive thematic methods.

Patients were described as reluctant to disclose their vaping for fear of being reported to authorities, and some clinicians were unsure of their duty to report, making it challenging to identify vaping cases. Variability in usage patterns and inaccurate e-liquid labelling posed difficulties in estimating nicotine dependence, leaving practitioners to trial and error or to adapt from smoking cessation guidelines. Tailored quit support for people who vape was lacking, especially in the form of subsidised nicotine replacement therapy.

Even in contexts where vaping is heavily regulated, given the rising incidence of vaping globally, it is important to record patients' vaping history as part of routine practice and to provide services to help people quit vaping without facing stigma or legal repercussions because of their vaping.